1. Left Ventricular Assist Devices: The What and the Who Lance E. Sullenberger MD FACC FACP Capital Cardiology Associates

2. US Heart Transplants StableBut Heart Failure Increasing…

3. Left Ventricular Assist Device Pulsatile Flow Not a true artificial heart. Assists the left ventricle in passing oxygenated blood through the body. Initially was a pulsatile device (similar to native heart…)

4. Left Ventricular Assist Device Continuous (Axial) Flow

5. Pulsatile Flow is Out Axial Flow is In

6. The Down Side Infection Bleeding Thrombosis Embolism Battery issues Hemolysis

7. Who Gets an LVAD? Bridge to Recovery Bridge to Transplant Destination Therapy

8. Bridge to Recovery Acute Myocarditis Acute Myocardial Infarction Peripartum Cardiomyopathy Younger Previously healthy Few comorbidities

9. Bridge to Transplant

10. Destination Therapy REMATCH Trial 129 patients Ineligible for cardiac transplant Class IV CHF ½ received LVAD ½ received medical therapy alone Can’t get a TX – Older – Hepatitis – DM with small vessel disease Might not get a TX – Renal issues – PHTN Complex surgical

11. Warning Signs!!

13. Inability to Take CHF Therapy

14. Low Sodium

15. Cardiorenal Syndrome

16. Warning Signs! Recurrent Admissions Low Blood Pressure Hyponatremia Poor Renal Function Use of Continuous Inotropes Increasing diuretic dose Worsening Heart Failure Class

17. Bring It Home….

18. LANCE SULLENBERGER MD LSULLENBERGER@CAPITALCARDIOLOGY.COM Thank You!!!